Fill and Sign the Motion Summary Judgment 497315359 Form

IN THE CIRCUIT COURT OF       COUNTY, MISSISSIPPI       AND       PLAINTIFFS VS. NO.             DEFENDANT RESPONSE TO DEFENDANT'S MOTION FOR PARTIAL SUMMARY JUDGMENT COME NOW the Plaintiffs,       and       , by and through counsel, and respond to Defendant's Motion for Partial Summary Judgment as follows, to - wit: I. INTRODUCTION This action is an alleged wrongful denial of benefits claim. The Plaintiffs have alleged that       hospital confinement at       from             ,       to             ,       , was pre - certified as a covered medical expense. On or about             ,       ,       sustained an injury and was admitted to       on that date by       and was discharged on             ,       . Following discharge,       went home and developed a fever and other complications due to his/her injuries. On or about             ,       ,       was seen by       and was admitted to       in       for treatment of a fever of unknown origin and lumbosacral strain.       was discharged from       on             ,       .       paid the physicians’ charges in connection with       admission to       from             ,       to             ,       .       , however, has denied the payment of charges to       for the             to             ,       admission stating that the hospitalization was not medically necessary. II. UNDISPUTED FACTS 1.       purchased a       Contract, Type       , covering himself/herself , his/her husband/wife ,       , and his/her children. 2.       sustained an injury on or about             ,       , and was seen by       and admitted to       and was discharged on             ,       . 3. On or about             ,       ,       was seen by       and was admitted to       in       for treatment of a fever of unknown origin and lumbosacral strain.       was discharged on             ,       . Affidavit of       is attached as Ex.       . 4.       pre - certified       admission. Affidavit of       is attached as Ex.       . 5. The hospital bill in questions was for $       , of which       owes the sum of $       . 6.       has denied payment of the hospital charges in connection with       treatment of       through             ,       , but has paid the physicians’ charges in connection with treatment of             ,       to             ,       . 7.       does not have an 'arguable defense' for denying       claim. It took       approximately       (       ) months from the time       claim was initially reviewed by its in - house physician and denied to send       claim to an independent physician for review. 8.       does not have a legitimate or arguable reason for denying       claim. III. ARGUMENT It is inconceivable that the Defendant could determine that       hospital confinement was not 'medically necessary,' when       had a fever of unknown origin and an injury to his/her       area. Neither the Defendant's in - house consulting physician or the independent outside consulting physician ever personally examined       .       is       family physician and was his/her attending physician when       was admitted to       .       personally examined       and knew the nature of       condition and knew that he/she needed to be hospitalized, based upon his/her examination of and his/her medical opinion. Further, the investigation made by       was late, inefficient, and not properly conducted. The Court should deny       any relief. The Plaintiffs are entitled to actual and punitive damages for Defendant's willful, wanton, malicious and intentional or grossly negligent acts in handling       claim. CONCLUSION There is genuine issue of material fact, and Summary Judgment is not appropriate in this instance. The Defendant is not entitled to judgment as a matter of law, and Defendant motion should be denied and this cause should proceed to trial on its merits. WHEREFORE, PREMISES CONSIDERED, Plaintiffs respectfully request that the Defendant's Motion for Partial Summary Judgment be dismissed and that this cause proceed to trial on its merits and for such other and additional relief as the Court may deem proper. RESPECTFULLY SUBMITTED, this the       day of       ,       .       and       BY:_____________________________________       OF COUNSEL: _________________________________________       CERTIFICATE I,       , attorney for Plaintiffs, do hereby certify that I have this date served via United States mail, postage prepaid, a true and correct copy of the above and foregoing Response to Defendant's Motion for Partial Summary Judgment upon:       This the       day of       ,       . _________________________________________